Clan Thompson's Celiac Site

Q & A

QUESTION: I have a question for the Dr. Rudert that arises from the newsletter. In an earlier issue she states "The majority of my patients also have B12 levels and folic levels drawn and may require coagulation studies and this is often determined on an individual basis." I had never heard of coag studies done on celiacs with B12 and folic acid issues. What would these coag studies be looking for? I've recently been told I have hypercoagulability, so I am really interested in why she would use these tests.

DR. RUDERT: When I decide to order any of a number of tests in a patient with Celiac disease, these are generally tailored to the individual after a detailed history is obtained. It is not unusual for patients with Celiac disease to malabsorb fat soluble vitamins A, D, E, and K. Some patients, therefore, may have prolonged clotting times as manifested by an abnormal PT or PTT. Some individuals may actually be "hypercoagulable", or have other associated hemotalogic abnormalities. It is not unusual to see patients with elevated platelet counts. I have even suspected vitamin E deficiency in some individuals with neurologic complaints.

Beware of fat substitutes such as Olestra (Olean) that are contained in a variety of food items. These products are often associated with diarrhea that may be confused with inadvertent gluten ingestion. Also, they are associated with the potential to lead to decreased absorption of fat soluble vitamins. If you notice on the packages, many of the products have actually added vitamins A, D, E and K. Finally, there is a medication called Questran (Cholestyramine) occasionally used in the treatment of cholesterol problems (and also used to treat diarrhea in patients after gallbladder surgery), that has been associated with fat soluble vitamin deficiencies if used on an ongoing basis. This may be more than you ever cared to know about vitamins A, D, E and K.

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